Superior mesenteric artery syndrome: an uncommon cause of intestinal obstruction; report of two cases and review of literature

Superior mesenteric artery [SMA] syndrome is caused by the compression of the third part of the duodenum leading to upper intestinal obstruction which is aggravated when the patient is lying in the supine position. Predisposing factors include rapid weight loss, application of a body cast after spinal surgery, prolonged recumbency, and abnormal position of the ligament of Treitz. Diagnosis may be difficult but can be confirmed by upper gastrointestinal contrast studies. Treatment is mainly conservative and if failed, surgical intervention is warranted. We report two children who were diagnosed with SMA syndrome and discuss the clinical picture, ways of diagnosis and methods of treatment

Recurrent splenic sequestration in a Kuwaiti boy with sickle cell disease

Children suffering from sickle cell disease are susceptible to different types of crises, such as acute vaso-occlusive, haemolytic, aplastic and sequestration crises. The classic acute sequestration crisis is a serious condition usually affecting black children, in which large amounts of blood are suddenly pooled into the spleen. The spleen suddenly enlarges markedly and signs of circulatory collapse rapidly develop, leading to death unless an emergency splenectomy is performed. Minor recurrent sequestration episodes have been recently reported in patients with sickle cell disease and a high fetal haemoglobin concentration. These episodes are of a milder presentation and outcome can be managed with repeated blood transfusions and later, elective splenectomy In this case report, we describe an Arab Kuwaiti boy with recurrent splenic sequestration who was treated with elective splenectomy, and propose a policy for the management of such patients

Childhood nocturnal enuresis: a problem to be solved

Nocturnal enuresis is a common problem in paediatrics which causes concern for the child, his parents, and the treating paediatrician. Although the physiopathology is not yet well understood, the most accepted theory is that there is a delay in the development of the micturation reflex, a condition with a genetic predisposition. Management includes a detailed history, a thorough physical examination, and investigations to exclude pathologic causes. Treatment is based on achieving a good communication with the child and his parents by explanation of the benign course and the high spontaneous remission rate, behavioral and conditioning therapy with the use of a buzzer alarm and the gold star chart, and finally the introduction of drugs to accelerate remission; these include imipramine, oxybutinine, and desmopressin